构建医学影像存档和通讯系统的初步探讨

目的 分析我院放射科医学影像数据存档和通讯系统（PACS）的实施，探讨PACS系统构建的优化方案。方法网络系统设计，利用原有网络及布线资源，将我院的CT、MRI、DSCR／DR、数字胃肠等数字化医疗设备构成局部的树形拓扑结构，完成中心存储系统；与合作公司共同研发了适合本科实际的RIS系统；RIS、HIS、PACS的分步整合应用。结果（1）研发的RIS系统充分满足了临床实际工作的需要。（2）数字化影像设备网络连接，并通过交换机把已有数字化设备连接，完成影像数据的集中光盘刻录保存。（3）应用Worklist功能完成CR／DR病人基本信息的写入，保证了病人信息的一致和正确性。结论该系统通过分步实施，为以后建立大型系统打下了良好的技术基础，是今后PACS系统发展的先期准备。     

一种小型PACS系统的设计与实现

目的 以我院成像设备的数字化改造，并建立PACS为例，探讨适合我国国情的PACS的设计模式。材料与方法 对我院现有非数字化或非DIC0M标准影像设备进行了数字化改造，继而开发了PACS网络系统，然后将其并入我院HIS内，实现了数字影像的网络传输功能。结果 影像系统所有分立设备均配接了KY系列影像工作站和激光打印机，既能进行影像数字化采集、存储、图像后处理及图像打印输出，又可以作为PACS的显示终端，并与网络服务器连接，成功地完成了PACS的设计与运行。结论 目前在我国非数字化或非DICOM标准成像设备配置占主体的状况下，建立适合我国国情的PACS的设计模式是切实可行的。     

三级存储模式在基层医院PACS系统中的应用

目的：探索在线、近线和离线三级存储模式在基层医学影像存储与传输系统PACS中的具体应用，从而解决基层PACS系统中医学影像数据长期存储的实际问题。方法：通过主服务器冗余存储磁盘阵列（RAID）实现影像数据的在线存储：通过NAS（network attached storage）系统实现影像数据的近线存储；通过磁带机实现影像数据的离线存储。结果：在三级存储模式运用于PACS系统中的近1年时间．医院完全保障了PACS系统中影像数据的长期存储，既实现了海量数据的在线访问．又能保证在线数据因人为破坏或火灾等原因造成丢失时影像数据的完整性。结论：三级存储模式在PACS系统中的应用．其投入成本和运行成本低、维护简单、性能可靠，可成为基层医院的理想模式。     

PACS影像诊断工作站的管理与维护

目的：探讨PACS影像诊断工作站的管理与维护。方法：采用××公司的PACS系统，影像科接入PACS系统的设备有CT、MRI、CR、DR及各种造影机共16台，所得影像数据均符合DICOM3．0标准，影像科安装影像诊断工作站36台。在远程控制工作站上利用Radmim远程管理工具，实现对所有影像诊断工作站的管理与维护。结果：经12个月的运行，实现了放射科影像诊断工作站的远程管理和控制。结论：影像诊断工作站是PACS系统的末端设备，是影像科室医师工作的主要工具，其管理与维护是确保临床诊断工作顺利进行、PACS系统安全稳定的重要环节之一。     

预防性维护在PACS管理中的应用

目的：通过科学的、规范化的PACS预防维护,降低PACS故障的发生,确保系统应用稳定。方法：总结PACS特点和维护经验,制定相应的预防性维护（PM）计划和规范化管理制度。结果：成熟的PACS软件加上良好的预防维护,系统经过多年使用后,仍能稳定正常运行。结论：PACS涉及复杂的软件和硬件技术,相比医疗设备更需要预防性维护。     

用硬盘代替光盘作为PACS影像数据存储管理的评价

目的：探讨用硬盘技术实现PACS影像数据近线存储和离线存储管理方案的可行性。方法：以宁波市第二医院PACS影像数据存储管理为例,介绍硬盘存储方案的架构和实施,并与原光盘存储方案对比分析。结果：利用硬盘技术建成可容纳14个月的PACS影像数据近线存储,20个月内影像数据无需调用离线数据。硬盘存储在优化存储方式、存放空间、使用成本、调用耗时、影像读取速度等指标均优于光盘存储方式。结论：应用硬盘存储技术可优化PACS影像数据的存储管理和提高放射科的工作效率。     

医学影像存储与传输系统的流程优化

目的：集成医学影像存储与传输系统（PACS）与医院信息系统（HIS）,提高PACS的效率,提升用户的使用体验。方法：对系统应用中存在的问题进行深入分析,采用流程优化、软件优化和硬件升级的方式对PACS进行优化。结果：实现了PACS与HIS的互联,提高了PACS的整体性能,提升了用户的使用体验,扩展了PACS的应用范围。结论：确定优化方案前应深入分析现有问题,以系统流程、软件环境的优化为主,硬件设备的升级更换为辅。     

虚拟专用网(VPN)技术在PACS系统中的应用

目的：探索虚拟专用网（virtual private network,VPN）技术在医学影像存储与传输系统（picture archiving and communication system,PACS）中的应用,从而实现PACS系统的远程访问及管理.方法：客户端（即远程计算机）基于ADSL等宽带接入Internet,PACS系统中的Web服务器通过带有VPN功能的宽带路由器接入Internet,运用VPN技术,使远程计算机与PACS系统中的Web服务器实现远程访问;PACS系统管理员在VPN基础上,对放射科内部网络的普通故障进行诊断和维护,实现远程管理.结果：在VPN技术运用于PACS系统中的半年时间内,医院真正实现了PACS的远程访问与管理,为医疗诊治提供了方便,同时提高了工作效率.结论：VPN技术在PACS系统中的应用,投入和运行成本低、维护简单、性能可靠,可实现对PACS系统远程访问与管理的目的.     

医学影像存档与通讯系统的开发与应用

目的 组建简便医学影像存档与通讯系统及通过PACS实现影像诊断设备的网络化，诊断报告书写计算机化、标准化。方法CT、MRI、DR、CR、DSA和通过工作站连接成医学数字影像传输（DICOM）网络；DICOM服务器与各图像浏览及诊断报告书写终端连接成以太网（Ethernet）网络；二者再通过集线器连接成PACS。结果成功地实现了数字化图像在PACS内的传送、中心存储、异机图像处理，不同操作系统（UNIX和Windows 2000）、不同格式图像（Adv和Dic）在DICOM3．0标准水平的相：互兼容和图像交流，以及诊断报告的书写与共亨打印等功能。结论PACS提高了工作效率及管理水平，推动了医生工作模式的变革；方便了工作、科研和学习；提高了教学质帚。规范化、计算机化的诊断报告质量优于人工书写报告。     

PACS影像采集与通信的应用与维护

目的：发展和完善全院性PACS，提高其应用水平，使影像工作能更高效地服务于诊疗活动。方法：利用PACS基本理论，结合DICOM标准，对影像采集与通信过程进行分类研究；在实践中通过效果对比等方法寻找最佳实施方案并探索PACS应用与维护的一般经验。结果：解决了PACS影像采集与通信中存在的常见问题，成功地维护了全院性PACS的正常运行;结论：PACS影像采集应当视设备情况采用合理、正确的采集方法，PACS的高效通信要通过采用科学的硬件设计方案和软件策略来实现。     

影像数据传输及存储的低成本实现

目的：依靠现有资源组建小型局域网,实现大型医用设备影像数据的传输和低成本存储。方法：基于TCP/IP和DICOM协议,建立Efilm workstation与各大型医用设备间的通讯,组建mini-PACS。结果：传输快速通畅,无数据丢失,实现了以光盘为介质存储影像数据,大大降低了成本,便于数据的导入、导出、再现、教学演示。结论：该方法简单可行,对中小医院具有一定的推广价值。     

PACS系统的技术管理

本文阐述了PACS系统在医院数字化和信息化建设中的重要性.对PACS系统与传统人工操作方法进行了比较,得出结论：PACS系统的实施,降低了医疗成本,提高了医院医疗质量;提高了工作效益、社会效益和军事效益;提高了影像诊断的水平;实现了图像高保真实时传输;实现了远程会诊;实现了影像资料共享;极大方便了医疗、教学及科研.系统的管理和维护则是PACS得以实现的重要保证.本文介绍了我院影像科PACS系统,并对PACS系统的技术管理作一个比较全面的总结.     

社区卫生服务机构PACS建设成本与效益分析

运用定性和定量研究方法,通过对比研究,对医学图像存档与通讯系统(PACS)的效果和效益进行分析。结果显示,利用PACS后,优化了服务流程,摄片流程平均需要10min,比对照组节省了20min;提高了经济效益,实行PACS后平均每张摄片成本为29.91元,低于对照组的39.03元;提高了服务质量。     

Achieving the promise of PACS today

Picture archiving and communication systems (PACS) were introduced in the 1980s as the ultimate solution for managing radiological films, but technical limitations and high costs prevented all but a few well-funded institutions from experimenting with PACS. Today, technology is catching up with the early vision of PACS. Partial-PACS solutions can be applied to specific departmental needs and be part of a planned migration toward filmless radiology. The most prevalent PACS solutions today are teleradiology reading stations that enable a department to deliver images over the telephone lines to on-call radiologists' homes, but other applications are growing rapidly. Benefits include more timely patient treatment, increased productivity, elimination of lost films and reduced costs in labor, film and supplies. Each facility must carefully weigh the objectives for a PACS solution and perform a careful cost/benefit analysis before acquiring a system.     

Cost-effectiveness prospects of picture archiving and communication systems

PAC (picture archiving and communication) systems are widely discussed and promoted as the organizational solution to digital image management in a radiology department. For approximately two decades digital imaging has increasingly been used for such diagnostic modalities as CT, DSA, MRI, DR (Digital Radiography) and others. PACS are seen as a step toward high technology integration and more efficient management. Although the acquisition of such technology is investment intensive, there are well-founded projections that prolonged operation will prove cost justified. Such justification can only partly be derived from cost reduction through PAC with respect to present department management - the major justification is preparation for future economic pressures which could make survival of a department without modern technology difficult. Especially in the United States the political climate favors ‘competitive medicine’ and reduced government support. Seen in this context PACS promises to speed the transition of Health Care Services into a business with tight resource management, cost accounting and marketing. The following paper analyzes cost and revenue in a typical larger Radiology Department, projects various scenarios of cost reduction by means of digital technology and concludes with cautious optimism that the investment expenses for a PACS will be justified in the near future by prudent utilization of high technology.     

PACS系统在医学影像管理中的应用和前景

计算机和通信技术的广泛应用,数字化技术的飞速发展,在影像数字化管理中使用计算机取代胶片保存,PACS正是这种思想趋势的结果。PACS系统的建设使医院降低了经营成本,提高工作效率和提高医院的医疗水平。     

探讨PACS的应用

目的介绍了我院医学影像存档与通信系统的一些应用。方法把具有医学数字成像及通信的影像设备连接到医院的PACS。结果PACS系统实现了统一存储和资源共享。结论PACS的应用方便了工作、教学、科研和会诊,提高医院的社会效益和经济效益。     

Issues in the evaluation of picture archiving and communication systems

Picture archiving and communication systems (PACS) are an example of the application of computer technology in the medical field. PACS automates image handling in a hospital and has the potential to transform the way radiology is currently performed. This paper focuses on the evaluation of the PACS technology, and considers the claims that have been made for PACS, how these claims might be turned into questions to be addressed by evaluation and the appropriate methods for the evaluation of PACS. A distinction is drawn between evaluation questions for which the hospital is the appropriate focus and those for which the patient is the appropriate focus. The preferred research design is different for hospital focused PACS evaluation and patient-focused evaluation of small scale PACS systems. A contemporaneous experimental comparison within hospitals is the preferred design for the patient-focused evaluation of small scale PACS systems. The patient-focused evaluation of large scale systems and the hospital-focused evaluation of all PACS systems could feasibly be conducted as contemporaneous experimental comparisons between hospitals but the large research costs implied by such a design almost certainly mean that non-contemporaneous, non-experimental comparisons within hospitals are more realistic. The current situation for the PACS technology is that it has potential, but as yet unproven, benefits and a large capital cost. Thus, the primary purpose of funding additional PACS implementations must be to add to the currently small body of evaluation evidence.     

PACS在医学影像教学中的应用

目的:探索和讨论医学院校数字化建设中影像存档与传输系统(PACS)在医学影像教学中的应用。方法:将50名学员按学习成绩排列并随机分为2组,分别用传统PPT教学法和PACS系统对相同内容进行教学,课后对授课内容进行随堂考核并发放学生调查问卷。结果:使用PACS系统授课的学生比使用原始PPT教学法授课的学生考核平均成绩提高3分;学生对PACS系统及医学影像学的兴趣逐步提高。结论:PACS系统有利于提高学生的学习兴趣及医学影像学教学质量。此种图像处理技术与网络化通信以及计算机技术相结合的产物,在逐步应用于临床医疗的同时,也为医学院校的医学影像教学提供了更先进的手段。     

Evaluation of a hospital picture archiving and communication system

OBJECTIVES: To establish the net costs to the hospital and the broad range of benefits associated with a hospital-wide picture archiving and communication system (PACS) that comprised digital acquisition, storage and transmission of radiological images via a hospital-wide network to 150 workstations. METHODS: 'Before and after' comparisons and time series analyses at Hammersmith Hospital (London, UK), and comparison with five other British hospitals where PACS was not being installed. The cost analysis considered implementation costs and changes in key elements of hospital running costs, including the impact of changes in the length of inpatient stays. A range of benefit measures were investigated, including image availability, avoidance of repeat imaging, avoidance of exposure to radiation, patient turn-round speed, time from examination to image availability in intensive care, avoidance of diagnostic 'errors' by casualty doctors, the additional diagnostic value of PACS-based images and clinician satisfaction. RESULTS: The annual equivalent capital cost of the PACS was 1.7 million Pounds (annual equivalent replacement cost: 0.8 million Pound). Overall, the PACS substantially increased running costs. No convincing evidence of a PACS-induced change in length of inpatient stay was found. PACS was associated with some improvements in the performance of the radiology department: improved image availability (97.7% versus 86.9%), lower repeat imaging rate (7.3% versus 9.9%) and 20% lower total radiation doses for examinations of the lateral lumbar spine. No improvements were identified in the quality of the radiology reporting service. Benefits outside radiology included shorter time from examination to image availability for routine uses in intensive care (19 versus 37 minutes), and a lower rate of diagnostic 'errors' in casualty (0.65% versus 1.51%). High levels of satisfaction with PACS were found amongst both providers and clinical users. CONCLUSIONS: PACS was almost universally preferred by users and brought many operational and clinical benefits. However, these advantages came at a significant capital and net running cost.